Abstract: Background　With the gradual aging of China's population and the gradual rise of chronic disease co-morbidities, cardiometabolic co-morbidities (CMM) have become one of the most damaging co-morbidities. Current studies on prediction and intervention methods for CMM have focused on individual cardiovascular diseases and lifestyle, while studies on CMM as a whole are lacking. Objective: To explore the association of Continuous metabolic syndrome score(cMetS) and other obesity indicators with CMM, and to further confirm whether these indicators can be used as a simple indicator for screening CMM, as well as to estimate the threshold for prediction of CMM in the middle-aged and elderly population in China. Methods　The study used 131,390 screeners from the Early Screening and Comprehensive Intervention Programme for People at High Risk of Cardiovascular Disease in Anhui Province from 2017-2021 as the study subjects, and collected their demographic information, cardiovascular health status, physical examination indexes, and laboratory biochemical indexes, and also computed the cMetSs and the indexes such as WHtR, WHT.5R, BRI, and BMI. The study population was divided into CMM and non-CMM groups to differentiate the prevalence of each age group and to compare the differences in each predictor between the two groups. Work characteristics (ROC) curves of subjects with CMM assessed by cMetS, WHtR, WHT.5R, BRI, and BMI were plotted and compared. Results　Among 131,390 subjects, 53,799 were males, 779 (1.4%) in the CMM group, and 77,591 were females, 866 (1.1%) in the CMM group.CMetS, WHtR, WHT.5R, BRI, and BMI were higher in the CMM group than those in the non-CMM group (P < 0.05). Multifactorial logistic regression analyses showed an increased risk of developing CMM in the Q2-Q4 group for all indicators compared with the Q1 group. After adjusting for confounders compared to Q1, the risk of developing CMM was the highest in all cMetS Q4 groups across sexes, 29.182 (19.698-43.232) in males and 31.809 (22.433-45.127) in females. The risk of prevalence of WHtR and BRI was the same across the sexes, 3.548 (2.736- 4.601) for males and 3.256 (2.542-4.171) for females.WHT.5R and BMI had a slightly lesser risk of prevalence across the sexes. Among the five predictors, the best performing cMetS across sexes had an area under the ROC curve (AUC) of 0.702 in men and 0.715 in women, with optimal cut-off values of 0.58 in men and 0.49 in women. The AUCs of WHtR, WHT.5R, BRI, and BMI were 0.646, 0.639, 0.646, 0.614, and 0.614, respectively, in men; and 0.646, 0.639, 0.646, 0.646, 0.646, 0.646, 0.646, and 0.646, 0.646 and 0.646, respectively, in women, 0.614; in women the AUCs of WHtR, WHT.5R, BRI and BMI were 0.663, 0.652, 0.663, 0.617 respectively. the predictive values of WHtR and BRI were also identical in different genders. the predictive values of WHT.5R and BMI were the worst. Conclusion　The cMetS and other obesity indicators were strongly associated with CMM in different genders, and the cMetS was better than the rest of the indicators in identifying CMM.CMetS can be used as a novel indicator for diagnosing CMM and is important in the prevention of CMM.

Key words: Cardiometabolic co-morbidities, Continuous metabolic syndrome score, Obesity indicators, Anhui province, A Ccross-Sectional study

摘要： 背景　随着中国人口逐步老龄化及慢性病共病人群的逐步上升，心脏代谢性共病（CMM）已成为危害性最大的共病之一。目前对于CMM的预测和干预方法的研究多集中于单个心血管疾病和生活方式，而缺乏针对CMM整体的研究。目的 　探讨代连续代谢综合征评分（cMetS）及其他肥胖指标与CMM的相关性，并进一步确认这些指标是否可作为筛查 CMM 的简易指标，以及估计中国中老年人群中预测CMM的临界点。方法　研究采用了2017-2021年在安徽省心血管病高危人群早期筛查与综合干预项目中的131 390例筛查者为研究对象，收集其人口学信息、心血管健康状况、体格检查指标，并进行实验室生化指标测定，同时计算cMetS和WHtR、WHT.5R、BRI、BMI等指标。将研究对象分为 CMM 组和非 CMM 组，区分各年龄段患病率，比较两组各个预测指标的差异性。绘制并比较cMetS、WHtR、WHT.5R、BRI和BMI评估 CMM 的受试者工作特征（ROC）曲线。结果　131390例受试者中男53 799例，CMM 组779例（1.4%）；女77 591例，CMM组866例（1.1%）。CMM组cMetS、WHtR、WHT.5R、BRI和BMI均高于非CMM组(P ＜0.05）。多因素logistic回归分析结果显示，与Q1组相比，所有指标Q2-Q4组患CMM风险均增加。在调整混杂因素后与Q1相比，不同性别中cMetSQ4组发生CMM风险均为最高，男性为29.182（19.698-43.232），女性为31.809（22.433-45.127）。WHtR和BRI在不同性别中患病风险完全相同，男性为3.548（2.736-4.601），女性为3.256（2.542-4.171）。WHT.5R 和BMI在不同性别中的患病风险稍次之。在5个预测指标中，在不同性别中cMetS表现最好ROC曲线下面积（AUC）分别为男性0.702，女性0.715，最佳临界值分别为男性0.58、女性0.49。 在男性中WHtR、WHT.5R、BRI和BMI等指标的AUC分别为0.646、0.639、0.646、0.614；在女性中WHtR、WHT.5R、BRI和BMI等指标的AUC分别为0.663、0.652、0.663、0.617。WHtR和BRI在不同性别中的预测价值也完全相同。WHT.5R和BMI的预测价值最差。结论　在不同性别中，cMetS和其他肥胖指标均与CMM密切相关，且在识别CMM方面cMetS优于其余指标。cMetS可作为诊断CMM的一项新型指标，在预防CMM方面具有重要意义。

关键词: 心脏代谢性共病, 连续代谢综合征评分, 肥胖指标, 安徽省, 横截面研究